Healthcare Provider Details

I. General information

NPI: 1639559933
Provider Name (Legal Business Name): WESTCARE TENNESSEE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 N GATEWAY AVE
HARRIMAN TN
37748-8609
US

IV. Provider business mailing address

PO BOX 94738
LAS VEGAS NV
89193-4738
US

V. Phone/Fax

Practice location:
  • Phone: 865-234-7030
  • Fax: 865-882-9411
Mailing address:
  • Phone: 702-385-2090
  • Fax: 702-924-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT NERI
Title or Position: CHIEF SERVICES AND PROGRAMS OFFICER
Credential:
Phone: 727-490-6767